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Update in Pediatric Rheumatology

  • Roberta A. Berard
  • Ronald M. Laxer
Chapter

Abstract

There have been exciting advances in the recognition, diagnosis and management of autoimmune and autoinflammatory conditions. The focus of this chapter will be an update on the assessment of pediatric musculoskeletal (MSK) complaints for the general practitioner, the diagnosis and management of juvenile idiopathic arthritis (JIA), non-inflammatory MSK causes of pain, macrophage activation syndrome and a review of the most common autoinflammatory diseases (periodic fever syndromes).

References

  1. Albers HM, et al. Time to treatment as an important factor for the response to methotrexate in juvenile idiopathic arthritis. Arthritis Rheum. 2009;61:46–51.  https://doi.org/10.1002/art.24087.CrossRefPubMedGoogle Scholar
  2. Behrens EM, Beukelman T, Paessler M, Cron RQ. Occult macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis. J Rheumatol. 2007;34:1133–8.PubMedGoogle Scholar
  3. Ben-Chetrit E, Touitou I. Familial mediterranean Fever in the world. Arthritis Rheum. 2009;61:1447–53.  https://doi.org/10.1002/art.24458.CrossRefPubMedGoogle Scholar
  4. Bleesing J, et al. The diagnostic significance of soluble CD163 and soluble interleukin-2 receptor alpha-chain in macrophage activation syndrome and untreated new-onset systemic juvenile idiopathic arthritis. Arthritis Rheum. 2007;56:965–71.  https://doi.org/10.1002/art.22416.CrossRefPubMedGoogle Scholar
  5. Broughton T, Armon K. Defining juvenile idiopathic arthritis remission and optimum time for disease-modifying anti-rheumatic drug withdrawal: why we need a consensus. Paediatr Drugs. 2012;14:7–12.  https://doi.org/10.2165/11595980-000000000-00000.CrossRefPubMedGoogle Scholar
  6. Burton MJ, Pollard AJ, Ramsden JD, Chong LY, Venekamp RP. Tonsillectomy for periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA). Cochrane Database Syst Rev. 2014;9:CD008669.  https://doi.org/10.1002/14651858.CD008669.pub2.CrossRefGoogle Scholar
  7. Cacchio A, De Blasis E, Necozione S, di Orio F, Santilli V. Mirror therapy for chronic complex regional pain syndrome type 1 and stroke. N Engl J Med. 2009;361:634–6.  https://doi.org/10.1056/NEJMc0902799.CrossRefPubMedGoogle Scholar
  8. Cassidy J, et al. Ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics. 2006;117:1843–5.  https://doi.org/10.1542/peds.2006-0421.CrossRefPubMedGoogle Scholar
  9. Cochard M, et al. PFAPA syndrome is not a sporadic disease. Rheumatology. 2010;49:1984–7.  https://doi.org/10.1093/rheumatology/keq187.CrossRefPubMedGoogle Scholar
  10. Doherty M, Dacre J, Dieppe P, Snaith M. The ‘GALS’ locomotor screen. Ann Rheum Dis. 1992;51:1165–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Federici S, Gattorno M. A practical approach to the diagnosis of autoinflammatory diseases in childhood. Best Pract Res Clin Rheumatol. 2014;28:263–76.  https://doi.org/10.1016/j.berh.2014.05.005.CrossRefPubMedGoogle Scholar
  12. Foster HE, Jandial S. pGALS – paediatric Gait Arms Legs and Spine: a simple examination of the musculoskeletal system. Pediatr Rheumatol Online J. 2013;11:44.  https://doi.org/10.1186/1546-0096-11-44.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Foster HE, Kay LJ, Friswell M, Coady D, Myers A. Musculoskeletal screening examination (pGALS) for school-age children based on the adult GALS screen. Arthritis Rheum. 2006;55:709–16.  https://doi.org/10.1002/art.22230.CrossRefPubMedGoogle Scholar
  14. Foster H, Rapley T, May C. Juvenile idiopathic arthritis: improved outcome requires improved access to care. Rheumatology. 2010;49:401–3.  https://doi.org/10.1093/rheumatology/kep347.CrossRefPubMedGoogle Scholar
  15. Garavello W, et al. Tonsillectomy in children with periodic fever with aphthous stomatitis, pharyngitis, and adenitis syndrome. J Pediatr. 2011;159:138–42.  https://doi.org/10.1016/j.jpeds.2010.12.014.CrossRefPubMedGoogle Scholar
  16. Gattorno M, et al. A diagnostic score for molecular analysis of hereditary autoinflammatory syndromes with periodic fever in children. Arthritis Rheum. 2008;58:1823–32.  https://doi.org/10.1002/art.23474.CrossRefPubMedGoogle Scholar
  17. Gershoni-Baruch R, et al. The contribution of genotypes at the MEFV and SAA1 loci to amyloidosis and disease severity in patients with familial Mediterranean fever. Arthritis Rheum. 2003;48:1149–55.  https://doi.org/10.1002/art.10944.CrossRefPubMedGoogle Scholar
  18. Goff I, Rowan A, Bateman BJ, Foster HE. Poor sensitivity of musculoskeletal history in children. Arch Dis Child. 2012;97:644–6.  https://doi.org/10.1136/archdischild-2011-300853.CrossRefPubMedGoogle Scholar
  19. Gunz AC, Canizares M, Mackay C, Badley EM. Magnitude of impact and healthcare use for musculoskeletal disorders in the paediatric: a population-based study. BMC Musculoskelet Disord. 2012;13:98.  https://doi.org/10.1186/1471-2474-13-98.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Hashkes PJ, Toker O. Autoinflammatory syndromes. Pediatr Clin N Am. 2012;59:447–70.  https://doi.org/10.1016/j.pcl.2012.03.005.CrossRefGoogle Scholar
  21. Hayward K, Wallace CA. Recent developments in anti-rheumatic drugs in pediatrics: treatment of juvenile idiopathic arthritis. Arthritis Res Ther. 2009;11:216.  https://doi.org/10.1186/ar2619.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Heiligenhaus A, et al. Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol Int. 2012;32:1121–33.  https://doi.org/10.1007/s00296-011-2126-1.CrossRefPubMedGoogle Scholar
  23. Jandial S, Myers A, Wise E, Foster HE. Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills. J Pediatr. 2009;154:267–71.  https://doi.org/10.1016/j.jpeds.2008.08.013.CrossRefPubMedGoogle Scholar
  24. Long SS. Distinguishing among prolonged, recurrent, and periodic fever syndromes: approach of a pediatric infectious diseases subspecialist. Pediatr Clin N Am. 2005;52:811–35.  https://doi.org/10.1016/j.pcl.2005.02.007.CrossRefGoogle Scholar
  25. Lovell DJ, et al. Measuring process of arthritis care: a proposed set of quality measures for the process of care in juvenile idiopathic arthritis. Arthritis Care Res. 2011;63:10–6.  https://doi.org/10.1002/acr.20348.CrossRefGoogle Scholar
  26. Malleson PN, Mackinnon MJ, Sailer-Hoeck M, Spencer CH. Review for the generalist: the antinuclear antibody test in children – when to use it and what to do with a positive titer. Pediatr Rheumatol Online J. 2010;8:27.  https://doi.org/10.1186/1546-0096-8-27.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Minoia F, et al. Clinical features, treatment, and outcome of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: a multinational, multicenter study of 362 patients. Arthritis Rheumatol. 2014;66:3160–9.  https://doi.org/10.1002/art.38802.CrossRefPubMedGoogle Scholar
  28. Myers A, et al. More ‘cries from the joints’: assessment of the musculoskeletal system is poorly documented in routine paediatric clerking. Rheumatology. 2004;43:1045–9.  https://doi.org/10.1093/rheumatology/keh245[pii].CrossRefPubMedGoogle Scholar
  29. Oen K. Long-term outcomes and predictors of outcomes for patients with juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol. 2002;16:347–60.CrossRefPubMedGoogle Scholar
  30. Padeh S, et al. Familial Mediterranean fever in children presenting with attacks of fever alone. J Rheumatol. 2010;37:865–9.  https://doi.org/10.3899/jrheum.090687.CrossRefPubMedGoogle Scholar
  31. Petty RE, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.PubMedGoogle Scholar
  32. Petty R, Laxer R, Lindsey C, Wedderburn L. Textbook of pediatric rheumatology. 7th ed. Amsterdam: Elsevier; 2016.Google Scholar
  33. Ravelli A, et al. Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaboration. Arthritis Rheum. 2016;68(3):566–76.Google Scholar
  34. Roth-Isigkeit A, Thyen U, Stoven H, Schwarzenberger J, Schmucker P. Pain among children and adolescents: restrictions in daily living and triggering factors. Pediatrics. 2005;115:e152–62.  https://doi.org/10.1542/peds.2004-0682.CrossRefPubMedGoogle Scholar
  35. Siegal S. Benign paroxysmal peritonitis. Gastroenterology. 1949;12:234–47.PubMedGoogle Scholar
  36. Smith N, et al. Paediatric musculoskeletal matters (pmm)—collaborative development of an online evidence based interactive learning tool and information resource for education in paediatric musculoskeletal medicine. Pediatr Rheumatol Online J. 2016;14:1.  https://doi.org/10.1186/s12969-015-0062-4.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Tasher D, Somekh E, Dalal I. PFAPA syndrome: new clinical aspects disclosed. Arch Dis Child. 2006;91:981–4.  https://doi.org/10.1136/adc.2005.084731.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Ter Haar N, et al. Treatment of autoinflammatory diseases: results from the Eurofever Registry and a literature review. Ann Rheum Dis. 2013;72:678–85.  https://doi.org/10.1136/annrheumdis-2011-201268.CrossRefPubMedGoogle Scholar
  39. Thomas KT, Feder HM Jr, Lawton AR, Edwards KM. Periodic fever syndrome in children. J Pediatr. 1999;135:15–21.CrossRefPubMedGoogle Scholar
  40. Uziel Y, Chapnick G, Jaber L, Nemet D, Hashkes PJ. Five-year outcome of children with “growing pains”: correlations with pain threshold. J Pediatr. 2010;156:838–40.  https://doi.org/10.1016/j.jpeds.2009.11.078.CrossRefPubMedGoogle Scholar
  41. Weiser P. Approach to the patient with noninflammatory musculoskeletal pain. Pediatr Clin N Am. 2012;59:471–92.  https://doi.org/10.1016/j.pcl.2012.03.012.CrossRefGoogle Scholar
  42. Yalcinkaya F, et al. A new set of criteria for the diagnosis of familial Mediterranean fever in childhood. Rheumatology. 2009;48:395–8.  https://doi.org/10.1093/rheumatology/ken509.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of Paediatrics, Children’s Hospital, London Health Sciences CentreWestern UniversityLondonCanada
  2. 2.Division of Rheumatology, The Hospital for Sick Children, Department of Paediatrics and MedicineUniversity of TorontoTorontoCanada

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